Data shows that pandemic has undone progress on antimicrobial resistance; Underscores need for continued investment and attention

By Kalvin Yu, MD, FIDSA, Vice President of U.S. Medical Affairs and Vikas Gupta, Pharm.D., Director of Medical Affairs

Throughout the long – and often unexpected – course of the COVID-19 pandemic, we’ve been proud of our ability to arm the U.S. Centers for Disease Control and Prevention (CDC) with timely, aggregate-level data on caseloads and hospitalization trends and share insights on how the U.S. health care system was faring against them. Most recently, we were key a contributor to the “COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022” released in mid-July.

The CDC report revealed that after more than two years of responding to COVID-19, antimicrobial resistance (AMR) has become a greater threat than before. Specifically, the report highlighted notable increases in infections across hospital-onset pathogens – as hospital-onset infections and deaths both increased at least 15 percent during the first year of the pandemic.

The pandemic forced public health resources to shift from tracking AMR to the constant surveillance of COVID-19 caseloads. This has been proven to be detrimental to AMR progress. Therefore, we wanted to build on the CDC report and share additional granularity on the key drivers of increasing AMR rates – based on our database of more than 250 health systems nationwide.

Outlined below are a few key stats from our data.

• As noted by the report, the rate of ESBL-producing Enterobacterales cases increased significantly. Notably, for those tested for COVID – our data show ESBL+ rates/1000 admissions increased from 2.15 in the pre-pandemic period to 2.95 from March 2020 and October 2021¹. This is particularly concerning since ESBL is a multidrug resistant bacterium, often spreads rapidly and is known to complicate infections in healthy patients.


• For hospital onset (HO) pathogens, AMR rates were significantly higher overall in the pandemic period – compared to lower rates of community onset pathogens. Of note, our data show the rate/1000 admissions of HO carbapenem resistant gram-negative pathogens were approximately 4.5-fold higher in COVID-positive patients compared to the pre-pandemic period (1.32 vs. 0.29)¹. Carbapenem antibiotics are some of the broadest last lines of defense for treating serious infections and losing efficacy would be a disaster for frontline clinicians.


• Lastly, the median hospital length of stay increased. Pre-pandemic hospital stays averaged 4.26 days – while the average was 4.56 days from March 2020 through October 2021. Unsurprisingly, patients who tested positive experience significantly longer stays (7.95 days) ¹. Longer stays are typically associated with more invasive devices and greater exposure to AMR – making COVID-positive patients more vulnerable to even higher rates of resistance.

We agree with the sentiment shared in CDC’s report, “These setbacks can and must be temporary. The COVID-19 pandemic has made it clear—prevention is preparedness.” As the CDC noted, pandemic-related challenges have resulted in a step backwards in the progress made against combating AMR. Finding the right balance of responding to the challenges of AMR and emerging threats simultaneously will be critically important in the future. We fully support the recommendations outlined by the CDC to achieve that balance:

• Studying antimicrobial resistance in community and healthcare wastewater – in the U.S. and globally.
• Expanding global capacities to fight AMR in the environment, as part of the Combating Antibiotic-Resistant Bacteria (CARB) National Action Plan.
• Mapping existing AMR ecology across One Health and monitoring shifts over time, also as part of the CARB National Action Plan.

In addition to the above, we believe two additional strategies are key. First, health leaders should pay additional attention to diagnostic stewardship programs to identify resistance in a timely manner. This will be critical to improve the use of antimicrobial therapy, given the high rates of resistant pathogens seen in COVID-tested patients. Second, as we have stated in previous blog posts, regional resistance rates should be accounted for to identify key geographic variations and impact.

About BD Infectious Disease Insights
Emerging infectious diseases have been increasing in frequency during the past few decades. None have tested the U.S. health care system’s capacity or resiliency like COVID-19 – forever changing the way that we think about future outbreaks and how we manage the related unintended consequences. The BD Infectious Disease Insights series investigates today’s most prominent infectious disease trends. The series leverages the depth and breadth of our data to serve as an ongoing bellwether on the state of infectious diseases in the U.S., backed by clinical insights on how to increase overall awareness and preparedness.

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